无创正压通气救治慢性阻塞性肺疾病呼吸衰竭高碳酸血症昏迷的疗效观察  

Effects of noninvasive positive pressure ventilation in chronic obstructive pulmonary disease with hypercapnic coma secondary to respiratory failure

作　　者：李秀[1] 王同[1] 丁震[1] 陈若静[1] 张春美[1] 吴祖凤[1] 张素萍[1] 

机构地区：[1]合肥市第一人民医院呼吸科,安徽合肥230061

出　　处：《中国呼吸与危重监护杂志》2007年第2期114-118,共5页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：合肥市科协基金项目(合科[2002]54号序号5)

摘　　要：目的观察无创正压通气（NPPV）治疗慢性阻塞性肺疾病（COPD）呼吸衰竭昏迷患者的疗效。方法对入选的32例COPDⅡ型呼吸衰竭昏迷患者和42例COPDⅡ型呼吸衰竭非昏迷患者在常规治疗的基础上行双水平无创正压辅助通气（BiPAP），动态观察治疗前后动脉血气、Glasgow昏迷评分（GCS）、NPPV天数、有效率及不良反应情况。结果昏迷组32例患者中30例经BiPAP通气后好转（2h后意识转清26例，3．8h意识转清3例，24h后完全清醒1例），血气分析指标好转，潮气量、每分通气量增加，通气（9±4）d恢复至稳定期状态，与非昏迷组（7±3）d比较差异无统计学意义（P〉0．05）。但昏迷组胃肠胀气的发生率高，较非昏迷组明显增加（80．5％比10．6％，P〉0．05）。两组间成功率没有明显差异（93．75％比97．62％，P〉0．05）。结论昏迷不是NPPV治疗的绝对禁忌证。Objective To study the effects of noninvasive positive pressure ventilation （NPPV） on chronic obstructive pulmonary disease （COPD） patients with hypercapnic coma secondary to respiratory failure. Methods COPD patients with or without coma secondary to respiratory failure were treated by bi-level positive airway pressure （BiPAP） ventilation on base of routine therapy. There were 32 cases in coma group and 42 cases in non-coma group. Arterial blood gas （ABG）, Glasgow coma scale （GCS）, days of NPPV ventilation, success ratio, and adverse effects were investigated. Results 30 patients in the coma group were improved after NPPV treatment （26 cases recovered consciousness treated by BiPAP in 2 hours,3 cases recovered from 3 to 8 hours, 1 case recovered after 24 hours）.The parameters of ABG,the tidal volume and the minute ventilation volume were improved after BiPAP.The time of effective therapy was （9± 4） days in the coma group and （7 ±3） days in the non-coma group with no significant difference （ P 〉 0.05） .The success ratio was similar in two groups （93.75% vs 97.62%, P 〉 0.05）. But the incidence of flatulence was higher in the coma group （80.5%） than the noncoma group （10.6%）. Conclusion Coma is not the absolute contraindication of NPPV treatment.

关 键 词：慢性阻塞性肺疾病 呼吸衰竭 高碳酸血症 昏迷 无创正压通气 

分 类 号：R563.9[医药卫生—呼吸系统]